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Hydroxyethyl Starch Reduces Coagulation Competence and Increases Blood Loss During Major Surgery: Results From a Randomized Controlled Trial

Rasmussen, Kirsten C. MD*; Johansson, Pär I. MD, DMSc, MPA; Højskov, Michael MD*; Kridina, Irina MD*; Kistorp, Thomas MD*; Thind, Peter MD, DMSc; Nielsen, Henning B. MD, DMSc*; Ruhnau, Birgitte MD*; Pedersen, Tom MD, DMSc§; Secher, Niels H. MD, DMSc*

doi: 10.1097/SLA.0000000000000267
Randomized Controlled Trials

Objective: This study evaluated whether administration of hydroxyethyl starch (HES) 130/0.4 affects coagulation competence and influences the perioperative blood loss.

Background: Artificial colloids substitute blood volume during surgery; with the administration of HES 130/0.4 (Voluven, Fresenius Kabi, Uppsala, Sweden) only a minor effect on coagulation competence is expected.

Methods: Eighty patients were scanned for enrolment in the study, and 40 patients fulfilled the inclusion criteria. Two patients withdrew their consent to participate in the study, and 5 patients were excluded. Thus, 16 patients were randomized to receive lactated Ringer's solution and 17 to receive HES 130/0.4.

Results: Among the patients receiving HES 130/0.4, thrombelastography indicated reduced clot strength (P < 0.001) and blinded evaluation of the perioperative blood loss was 2.2 (range 0.5 to 5.0) versus 1.4 (range 0.5 to 2.4) L in the patients who received HES 130/0.4 or lactated Ringer, respectively (P < 0.038). The patients in the lactated Ringer's group, however, received more fluid (P < 0.0001) than those in the HES 130/0.4 group. There was no significant difference between the 2 groups with regard to frequency of reoperations or the length of hospital stay, but use of HES 130/0.4 was both more expensive and less efficacious than the use of lactated Ringer.

Conclusions: Administration of HES 130/0.4 reduced clot strength and perioperative hemorrhage increased by more than 50%, while administration of lactated Ringer's solution provoked an approximately 2.5 times greater positive volume balance at the end of surgery.

Administration of hydroxyethyl starch 130/0.4 reduced coagulation competence and increased perioperative hemorrhage by more than 50% compared to administration of lactated Ringer's solution during major noncardiac surgery. The perioperative blood loss is minimized not only by careful surgical technique but also by maintaining coagulation competence.

*Department of Anesthesiology, The Abdominal Centre

Section for Transfusion Medicine

Department of Urology; and

§Center of Head and Ortopaedic Surgery, Rigshospitalet, University of Copenhagen, Denmark.

Reprints: Kirsten Cleemann Rasmussen, MD, Department of Anesthesiology, Rigshospitalet 2043, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail:

Disclosure: The sponsor of the trial was Rigshospitalet, University of Copenhagen, Denmark, and supported by grants from Aase and Ejnar Danielsen's Fond, Hartmann's Fond, L. F. Foght's Fond, Sophus and Astrid Jacobsen's Legat, Ove and Edith Olesen's Legat, and Arvid Nilsson's Fond, Denmark. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.